Clinical Presentations in ENT

Question 1

Prodromal illness with headache, malaise and fever before onset of sore throat, odyndophagia, neck pain and otalgia (caused by referred pain along glossopharyngeal nerve)
Tonsils enlarged and erythematous

Answer 1

tonsillitis

Question 2

Is cervical lymphadenopathy common in tonsillitis?

Answer 2

Yes

Question 3

Are exudates present in tonsillitis?

Answer 3

may be

Question 4

What may also be present in tonsillitis if viral?

Answer 4

rhinorrhoea and a productive cough

Question 5

Unilateral sore throat, odyndophagia, headache, ipsilateral otalgia, hot potato voice, drooling, peritonsillar swelling, deviaeted uvula

Answer 5

Peritonsillar abscess (quinsy)

Question 6

Does peritonsillar abscess tend to have cervical lymphadenopathy?

Answer 6

yes, unilateral

Question 7

sore throat accompanied by high fevers, enlarged tonsils bilaterally, rash, lymphadenopathy, haemorrhagic petechiae on the palate, splenomegaly, hepatomegaly, jaundice

Answer 7

glandular fever

Question 8

What is the lymphadenopathy like in glandular fever?

Answer 8

symmetrical cervical, axillary and inguinal

Question 9

Are there exudates in glandular fever?

Answer 9

Yes, tonsils are often completely covered by exudates

Question 10

Sore throat, trismus (lockjaw), fever and malaise
Patient has swelling in lateral pharyngeal wall which can cause displacement of the tonsil medially
Externally, there is often an erythematous upper lateral neck

Answer 10

parapharyngeal abscess

Question 11

Sore throat, odynophagia, dysphagia, neck stiffness, voice change, malaise, feeling of lump in throat
rarely can also present with spinal cord compression
May look normal on examination or may have posterior pharyngeal wall swelling
May also have fevers, rigors, unilateral lymphadenopathy or airway compromise

Answer 11

retropharyngeal abscess

Question 12

Sore throat

On examination, creamy white plaques on oropharynx

Answer 12

oral candida

Question 13

Rapid onset of sore throat, fever, odynophagia, cough, change in voice and otalgia
droopling, pyrexia, stridor, hoarse voice, cervical lymphadenopathy

Answer 13

Epiglottitis

Question 14

Initial causes sore throat, then 1-2 days later, red rash over the chest, which spreads to rest of body, sparing palms of hands, soles of feet and face
May see tonsillitis and pharyngitis
Red swollen STRAWBERRY TONGUE

Answer 14

scarlet fever

Question 15

Purulent nasal discharge, fever, sore throat
On examination, tonsil and oropharynx are initially discoloured white before forming a grey green membrane that can cause airway obstruction

Answer 15

diptheria

Question 16

Nasal congestion or discharge

May also have facial pain/pressure

Answer 16

rhinitis

Question 17

Epistaxis, loss of consciousness, breathing difficulties, swelling, bruising, nasal tenderness and deviation

Answer 17

nasal trauma

Question 18

frontal headache, purulent rhinnorrheoas, facial pain, tenderness and fever
severe pain and tenderness with purulent nasal discharge

Answer 18

sinusitis

Question 19

Worsened hearing and ability to understand speech due to high frequency hearing loss

Answer 19

prebycusis

Question 20

progressive, ipsilateral tinnitus with or without sensorineural hearing loss
Large tumour may cause unilateral cerebellar symptoms
giddiness common, vertigo rare
trigeminal nerve compression can lead to numb face

Answer 20

acoustic neuroma/vestibular schwannoma

Question 21

Impaired tympanic membrane mobility, hearing loss, poor school performance, behavioural problems, speech delay, balance problems
NO OTALGIA

Answer 21

Otitis Media with Effusion (GLUE EAR)

Question 22

Rapid onset otalgia, opaque/bulging tympanic membrane, impaired tympanic membrane mobility, may have hearing loss

Answer 22

Acute Otitis Media

Question 23

Foul discharge with/without deafness, headache, pain, facial paralysis, vertigo

Answer 23

cholesteatoma

Question 24

Tender mastoid and protruding auricle

Answer 24

mastoiditis

Question 25

severe pain as the drum becomes indrawn

Vertigo, tinnitus, deafness

Answer 25

barotrauma (aerotitis)

Question 26

earache, facial pain and joint clicking/popping related to malocclusion
joint pain exacerbated by lateral movement of open jaw/trigger points on pterygoids

Answer 26

TMJ dysfunction

Question 27

Redness and swelling of skin of outer ear canal, may be itchy (particularly in early stages), can become sore and painful, discharge, TRAGAL tenderness

Answer 27

otitis externa

Question 28

Prolonged vertigo, no tinnitus or hearing loss

Answer 28

vestibular neuronitis

Question 29

vertigo, tinnitus, hearing loss, fever

Answer 29

labyrinthitis

Question 30

Vertigo on looking up/turning in bed (often worse on one side), brief episodes

Answer 30

BPPV

Question 31

History of recurrent, spontaneous rotational vertigo, with at least 2 episodes over 20 mins, worsening of tinnitus and aural fullness on affected side

Answer 31

Meniere’s Disease

Question 32

Most frequent cause of stridor in infants and children, becomes worse with crying, agitation, excitement
poor weight gain, choking on food

Answer 32

Laryngomalcia

Question 33

common in rugby players, shearing forces to auricle, forms when blood vessels tear

Answer 33

pinna haematoma

Question 34

Smooth multiple bilateral swellings of bony canals

no symptoms, normally incidental

Answer 34

exotoses

Question 35

pain, otitis externa, vertigo (rare), perforated eardrum (very rare)

Answer 35

wax (secreted in outer third of canal)

Question 36

Bleeding from external canal due to lacteration of skin and ear drum, haemotympanum ossicular chain destruction, facial palsy, otorrhoea, CONDUCTIVE hearing loss

Answer 36

Longitudinal temporal fractures

Question 37

Sensorinueral hearing loss due to damage of 8th cranial nerve, facial nerve palsy, vertigo

Answer 37

Transverse temporal fractures

Question 38

conductive hearing loss, tinnitus, mild, transient vertigo

Answer 38

otosclerosis